Provider Demographics
NPI:1649263856
Name:HEGYI, JOSEPH P (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:HEGYI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 KEATON CROSSING BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8404
Mailing Address - Country:US
Mailing Address - Phone:636-614-4655
Mailing Address - Fax:
Practice Address - Street 1:4142 KEATON CROSSING BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8404
Practice Address - Country:US
Practice Address - Phone:636-614-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-10-05
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
MO2004030855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U71833Medicare UPIN